Videoconference Registration Form - Baseball Hall of Fame

National Baseball Hall of Fame Clubhouse

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Videoconference Registration Form

Name of School		*
School Address (City, State Zip)		*
Teacher's Name		*
Teacher's Phone Number		*
Teacher's Email Address		*
Tech Name		*
Tech Phone Number		*
Tech Email Address		*
Do you have a Hall of Fame Membership? (Note: Among other benefits, Hall of Fame members receive $25.00 off their videoconference.)		*
Membership Name
Membership Number
Invoice Info: Business Name
Invoice Recipient Name		*
Invoice Recipient Phone		*
Invoice Fax
Address of Business/Invoice Recipient (City, State Zip)		*
Invoice Recipient Email		*
Purchase order number
How would you like to receive your invoice?		*
Videoconference Date/Time (All times must be listed in EASTERN STANDARD TIME) (Note: Your preferred date/time may not be available. Selecting multiple dates will greatly improve your chances of scheduling a program in a timely manner) Enter as 00/00/00 and please include am/pm		*
2nd choice Date/Time (Enter as 00/00/00 and please include am/pm
3rd choice Date/Time (Enter as 00/00/00 and please include am/pm
Approximately how much time will you have for the videoconference program?		*
Videoconference topic		*
If other, please specify
Videoconference Level (Note: The Baseball Hall of Fame deals with a nation wide audience. The listed grades are only guidelines. Teachers should decide the appropriate level for their students based on the content of the program, and not on the listed grade level. Please carefully read through the unit content before deciding which level is best for your class)		*
If other, please specify
Number of participants		*
Grade Level of participants		*
Have you participated in a Hall of Fame videoconference before?		*
How did you find out about the Hall of Fame’s videoconference programs?		*
Comments

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